Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Sedative, Hypnotic or Anxiolytic Dependence

sedative, hypnotic or anxiolytic dependence in русский (Россия)

Related Terms

  • Antianxiety Drug Dependence
  • Barbiturate Dependence
  • Benzodiazepine Addiction
  • Prescription Drug Abuse
  • Prescription Drug Dependence
  • Tranquilizer Dependence

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

Factors Influencing Duration

The following may influence the outcome: the individual's readiness to change, the severity of the abuse or dependence/SHA use disorder, the success of the treatment program, appropriate patient-treatment matching, stable history of employment, and the presence of any physical complications.

Medical Codes

ICD-9-CM:
304.10 - Sedative, Hypnotic or Anxiolytic Dependence; Unspecified
304.11 - Sedative, Hypnotic or Anxiolytic Dependence; Continuous
304.12 - Sedative, Hypnotic or Anxiolytic Dependence; Episodic
304.13 - Sedative, Hypnotic or Anxiolytic Dependence; in Remission

Diagnosis

History: The possibility of substance abuse or dependency needs to be considered in any situation in which the individual has consistent, ongoing, or deteriorating problems in the presence of continuing use. The clinician needs to develop sensitivity to the diagnostic clues of impairment of social, emotional, occupational, or psychological functioning. Individuals frequently deny that a problem exists despite obvious signs of intoxication.

When the problems associated with SHA use coexist with evidence of tolerance, withdrawal, or compulsive behavior related to obtaining and administering the sedative, hypnotic or anxiolytic, a diagnosis of sedative, hypnotic or anxiolytic dependence rather than sedative, hypnotic or anxiolytic abuse should be entertained. However, individuals with abuse but not dependence can have some symptoms of tolerance, withdrawal, or compulsive use; hence it is important to determine whether the full criteria for dependence are met (DSM-IV-TR).

Individuals with SHA use disorder have a problematic pattern of SHA use leading to clinically significant impairment or distress, as manifested by 2 or more (as specified in the DSM-5) and at least 3 (as specified in the DSM-IV-TR) of the following, occurring within a one-year period: (1) sedatives, hypnotics, or anxiolytics are often taken in larger amounts or over a longer period than was intended; (2) there is a persistent desire or failed efforts to reduce or control SHA use; (3) much time is spent in activities necessary to obtain SHA, use SHA, or recover from its effects; (4) there is craving (a strong desire or urge to use SHA); (5) there is recurrent SHA use that results in a failure to fulfill major role obligations at work, school, or home; (6) there is continued SHA use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of SHA; (7) the individual gives up or reduces important social, occupational, or recreational activities because of SHA use; (8) there is recurrent SHA use when it is physically hazardous (driving an automobile or operating machinery when impaired by SHA use); (9) the individual continues SHA use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by SHA; (10) there is tolerance (a need for markedly increased amounts of SHA to achieve intoxication or desired effect, or a markedly diminished effect with continued use of the same amount of SHA); (11) there is withdrawal syndrome for SHA (see below) and the individual takes SHA (or a closely related substance, such as alcohol) to relieve or avoid withdrawal symptoms.

It is also necessary to specify the current severity: mild (presence of 2 to 3 symptoms), moderate (4 to 5 symptoms), or severe (6 or more symptoms) (DSM-5).

Severe physiological dependence, characterized by both tolerance and withdrawal, can develop to the sedatives, hypnotics, and anxiolytics. The timing and severity of the withdrawal syndrome will differ with the specific substance and its pharmacokinetics and pharmacodynamics. Evidence of tolerance and withdrawal may be present in the absence of a diagnosis of substance dependence if an individual takes benzodiazepines for long periods at prescribed and therapeutic doses, and discontinues them abruptly. The diagnosis of substance dependence should be considered only when the individual using the substance, in addition to having physiological dependence, shows evidence of a range of problems (e.g., drug-seeking behavior to the extent that important activities are given up or reduced to obtain the substance). In summary, the criteria of tolerance and withdrawal are not sufficient evidence of dependence for individuals taking sedatives, hypnotics, or anxiolytics under medical supervision (DSM-5).

Withdrawal syndrome for SHA appears after cessation of SHA use, and consists in at least two of the following: Autonomic hyperactivity (sweating or pulse rate greater than 100 bpm); hand tremor; insomnia; nausea or vomiting; transient visual, tactile, or auditory hallucinations or illusions; psychomotor agitation; anxiety; and grand mal seizures. The signs or symptoms develop within several hours to a few days after the cessation of SHA use; cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; are not attributable to another medical condition, and are not better accounted for by another mental disorder, including intoxication or withdrawal from another substance. It is necessary to specify if the syndrome courses with perceptual disturbances (DSM-5).

The course specifiers are: early full remission, early partial remission, sustained full remission, sustained partial remission, on agonist therapy, and in a controlled environment.

Physical exam: Physical exam may reveal signs of SHA dependence or prolonged use, including decreased heart rate (bradycardia), respiratory rate (bradypnea), and blood pressure (hypotension). Constant, involuntary, jerking movement of the eyeballs (nystagmus) is the single most useful finding seen in SHA dependence or intoxication. Physical signs of intoxication may include slurred speech; unsteady gait; loss of coordination; impaired thinking, memory, or attention; sluggishness; and tremor. Physical signs of withdrawal are hyperthermia, sweating, increased heart rate (tachycardia), increased hand tremor, insomnia, nausea or vomiting, transient hallucinations, psychomotor agitation, anxiety, or seizures. Characteristics of overdose include slow shallow breathing (respiratory depression), clammy skin, hypotension, stupor, shock, and coma. Death can follow if the hypotension and respiratory depression are not treated.

Tests: A polydrug urine screen should be ordered in case the individual is using drugs other than sedatives. Levels of specific SHA may also be determined. Both blood and urine samples may be used, but urine testing is generally the method of choice. A positive drug screen should always be confirmed by a second test, since it may result in serious consequences for the individual.

Additional tests are also recommended: blood for electrolyte disturbances, hypoglycemia, metabolic acidosis, hypoxia, hypercarbia; neurologic studies such as computed tomography (CT), electroencephalogram (EEG), or magnetic resonance imaging (MRI) for identifying other causes of the individual's condition such as structural brain lesions or seizure activity; and examination of cerebrospinal fluid (lumbar puncture) if an infectious cause of the condition is being considered.

Note: It must be kept in mind that just because a physical diagnosis cannot be established as the cause of the presenting symptomatology, it does not necessarily mean that the cause is a mental one. That is to say that the presence of medically unexplained symptomatology does not necessarily establish the presence of a psychiatric condition. The first step in identifying the presence of a mental disorder is excluding the presence of malingering and/or of factitious disorder. Although factitious disorder is conscious and purposeful, it is classified as a psychiatric disorder. The strong need for this step is especially true whenever there is a medicolegal context associated with the presenting problem(s). Additionally, using DSM-5 and/or ICD-9-CM or ICD-10-CM, the clinician will find that many presentations fail to fit completely within the boundaries of a single mental disorder. There are systematic ways to go about making psychiatric diagnoses, however.

Source: Medical Disability Advisor






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